LIFT Application and Eligibility Process Instructions - TriMet
LIFT Application and Eligibility Process Instructions - TriMet
LIFT Application and Eligibility Process Instructions - TriMet
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PART G. <strong>Instructions</strong> regarding signatures <strong>and</strong> submitting application to <strong>LIFT</strong><br />
Before returning the application, please make sure that:<br />
1. You answer all questions in Parts A through E.<br />
2. You sign Part F on Page 4.<br />
NOTE: If another person (not the applicant) completed the application, please<br />
have that person complete the information in Part F <strong>and</strong> sign the application.<br />
3. You complete <strong>and</strong> sign the attached Medical Release – Authorization For Use<br />
<strong>and</strong> Disclosure Of Protected Health Information on Page 6. The Medical<br />
Release form is available in large print upon request .<br />
It may be necessary for <strong>TriMet</strong> to contact a health professional who is familiar with<br />
your disability or health condition. <strong>TriMet</strong> will not release any medical information<br />
obtained with the release(s) you provide to any other party.<br />
Please use the enclosed self-addressed envelope or mail your application to:<br />
<strong>TriMet</strong> Transit Mobility Center<br />
515 NW Davis Street<br />
Portl<strong>and</strong>, OR 97209<br />
You may instead fax the application to (503)962-8229.<br />
If you have any questions or need assistance in completing the application, including an<br />
alternative format, please call the Transit Mobility Center at 503-962-8200, Option #4,<br />
TTY 503-962-8058.<br />
<strong>LIFT</strong> <strong>Application</strong> w/<strong>Instructions</strong> – 4-13-11.docx – www.trimet.org<br />
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